CHEMOTHERAPY AND LOW-DOSE RADIOTHERAPY IN THE TREATMENT OF HIV-INFECTED PATIENTS WITH CARCINOMA OF THE ANAL-CANAL

Purpose: To determine the efficacy and tolerance of a standardized pro tocol of chemotherapy and low-dose radiotherapy in the treatment of an al cancer in human immunodeficiency virus (HIV)-infected patients. Met hods and Materials: Between 1987 and 1995, eight HIV-positive patients with squamous cell carcinoma of the anal canal, four of whom had acqu ired immunodeficiency syndrome (AIDS), received therapy at the Raiser Permanente Medical Center. All patients were treated using a combined modality approach consisting of low-dose radiotherapy (30 Gy in 15 fra ctions delivered 5 days/week), and chemotherapy [1000 mg/m(2) of 5-flu orouracil (5-FU) delivered on days 1-4 and 29-32 as a continuous infus ion over 96 h, and 10 mg/m(2) of mitomycin C delivered as a bolus inje ction on day 1]. Patients have been followed from 4 to 81 months (mean 41, median 38). Results: All eight patients completed the therapy wit h minor variations to the protocol, and all have attained a clinical c omplete response. Four patients are alive and free of disease, and fou r died as a result of complications of AIDS, but remained free of anal carcinoma. There were no mortalities from the protocol and the morbid ity was acceptable. Only one patient each was noted to have Radiation Therapy Oncology Group/European Organization for Research and Treatmen t of Cancer Grade 4 hematologic and gastrointestinal acute toxicity, a nd no Grade 4 skin toxicity was noted. Conclusion: This combined thera py is effective for HIV-infected patients and appears to be tolerable with acceptable toxicities. It is best applied to patients who are HIV positive, or who have AIDS without concurrent major opportunistic inf ections. This approach is reasonable and affords patients a reasonably good chance at sphincter preservation by avoiding abdominoperineal re section. The optimal therapy for HIV-positive patients with advanced A IDS remains less well defined. (C) 1997 Elsevier Science Inc.